Kidney Failure Risk Equation and Risk of Kidney and Cardiovascular Outcomes in Patients with Heart Failure with...

Area of Science:

• Nephrology
• Cardiology
• Clinical Prediction Models

Background:

• The Kidney Failure Risk Equation (KFRE) is recommended for predicting kidney failure in chronic kidney disease (CKD).
• Its utility in patients with co-existing heart failure (HF) is not well-established.
• This study investigates KFRE performance in patients with heart failure with reduced ejection fraction (HFrEF) and CKD.

Purpose of the Study:

• To evaluate the association of 2- and 5-year KFRE scores with cardiovascular and kidney outcomes in patients with HFrEF and CKD.
• To explore KFRE performance using continuous scores, risk categories, and quartiles.

Main Methods:

• Analysis of 794 patients with HFrEF and eGFR < 60 ml/min/1.73m² from the PARADIGM-HF trial.
• KFRE score calculation using baseline urine albumin-creatinine ratio (UACR), age, sex, and estimated glomerular filtration rate (eGFR).
• Assessment of associations between KFRE scores and composite kidney outcomes (ESKD or 50% eGFR decline), cardiovascular death, HF hospitalization, and all-cause mortality.

Main Results:

• The median 5-year KFRE score was 0.63%. Higher baseline KFRE scores correlated with higher systolic blood pressure, NT-proBNP, and increased prevalence of diabetes, atrial fibrillation, and diuretic use.
• The 5-year KFRE score was not significantly associated with the composite outcome of ESKD or 50% eGFR decline (HR 1.45, P=0.10).
• Continuous 5-year KFRE scores were significantly associated with cardiovascular death or HF hospitalization (HR 1.22, P<0.001) and all-cause mortality (HR 1.24, P<0.001).

Conclusions:

• The KFRE demonstrates association with cardiovascular event risk in patients with HFrEF and CKD.
• The median KFRE score was low in this cohort, suggesting potential underestimation of risk.
• Validation in HF populations with more advanced CKD is necessary to confirm these findings.